REPORT FRONT SHEET
MB, ChB, BSc(Hons)MedSci, FRCSEd(A&E), FCEM, FIMC, RCSEd, DipFMS
Consultant in Emergency Medicine & Retrieval Medicine
Mr Scott R Hepburn MB, ChB, BSc(Hons)MedSci, FRCSEd(A&E), FCEM, FIMC, RCSEd, DipFMS. Graduate of Aberdeen University Medical School, with Bachelor of Medicine and Bachelor of Surgery, with associated intercollated Honours Degree in Medical Science. Full-time NHS Consultant in Emergency Medicine since April 2008, prior to which the previous 5 years was in higher Emergency Medicine training, sub-specialty interest in pre-hospital care and Aero-medical Retrieval Medicine. Full registration with the GMC, with specialty registration in Emergency Medicine. Fellow of The Royal College of Surgeons of Edinburgh, and Fellow of the College of Emergency Medicine, London. Extensive clinical experience all aspects of emergency care, including road traffic collisions, victims of assault and crime, accidents in the workplace and associated sub-groups. Full member of the Medical & Dental Defence Union of Scotland, and the British Medical Association. Attained Diploma in Forensic Medical Science from the Society of Apothecaries of London in August 2010. The following report is a full detailed personal injury medico-legal report in respect of the injuries sustained by Mrs
) as the result of being involved in a road traffic
collision on 8 December 2010. The examination report was prepared in the Emergency Department of the Western Infirmary, Glasgow following an arranged appointment on Thursday 24 March 2011 at 5.00pm. 3.2
In preparation of this report, as well as direct consultation and examination with Mrs
photocopies of her General Practitioner medical records. I also confirmed with Mrs
a written mandate authorising the release of medical information for the preparation of this report prior to commencing the consultation. 3.3
is a 6O year old lady who is currently working part-time at a Morrison’s Superstore as
a bakery assistant. She tells me that, prior to her involvement in the road traffic collision on 8 December 2010, she had a number of ongoing medical problems worthy of note:-
(a) She is a non-insulin dependent type II diabetic, which she tells me was diagnosed approximately 7 years ago. She tells me that this is reasonably well controlled on oral hypoglycaemics and she denies any long-term complications from her diabetes. (b) Essential hypertension, which she tells me is well-controlled on anti-hypertensives. (c) Hiatus hernia. (d) Previous episodes of low mood, labelled as “depressive disorder” in the General Practitioner records on 1 January 1989.
also tells me that she had been involved in a previous road traffic accident in 1996. She tells me that
on that occasion she was the passenger in a vehicle that was rear-ended by another vehicle. She was diagnosed with a “whiplash” injury, which affected predominantly the left side of her neck. She tells me that the symptoms from this injury largely settled after a 4 week period and that she did not require to take any time off work as a result of this. She tells me that she was also involved in a “trivial” road traffic collision in 2008 when reversing her vehicle in a car park. She tells me that this resulted in minor damage to the vehicles only and that no injuries sustained. Mrs
informs me that she presented to her General Practitioner on one occasion in August 2010 with an
episode of mechanical back pain, which she associated to doing some gardening at that time. She tells me that the symptoms from this resolved with the help of some simple painkillers over the course of a one week period. She tells me that, apart from the above episodes, she has not had any chronic or long-term problems with her back or neck. Mrs
informs me that she is currently prescribed the following medicine:- Metformin, Gliclazide, Co-amilofruse,
Amlodipine, Atorvastatin, aspirin and Lansoprazole. She is not known to be allergic to any medications. Mrs
tells me that she takes alcohol very occasionally, typically at New Year and other special occasions. She is
tells me that she is married and that she lives with her husband. It is worthy to note that Mr
recently been diagnosed with a recurrence of prostatic cancer and that he is currently receiving treatment at the Beatson Oncology Centre in Glasgow. I understand from Mrs
that he was originally diagnosed 2 years ago
and that he was subsequently diagnosed with a recurrence in or around October 2010. Mrs
up children, aged 38 and 33, who live away from home and who are not dependent on Mr and Mrs . Mrs
is employed as a bakery assistant, on a part-time basis, by Morrison’s Superstore in
I understand that she works 2 days a week, equating to a total of 10 hours a week (her hours of work are from 6.00am to 11.00am) and she may occasionally be required to work on a Saturday. Her working duties involve lifting heavy trays of bakery goods, in combination with typical food preparation and cleaning duties. She tells me that, outside of her work, she enjoys looking after her 3 spaniels and she walks them regularly. She is a keen gardener and, when the weather permits, she gardens on a daily basis. She also describes herself as enjoying various crafts, including needlework and sewing. Mrs
also actively involves herself in the care of her
grandchildren when her own children are at work and she regularly drives them to and from nursery. 3.4
was involved in a road traffic collision on 8 December 2010 at approximately 12.30pm. She tells me
that this was around the time of the extremely heavy snowfalls affecting Scotland and the roads were particularly snow covered and icy at that time; I understand that Mrs
was taking her 4 year old grandson from his nursery
to his pre-school nursery class at the time of the accident. She tells me that she was travelling along a road in Irvine and, upon her approach to a junction on the near-side, another vehicle failed to stop and impacted against the near-side of her vehicle.
She specifically recalls checking the speed of her vehicle immediately prior to the collision (which was approximately 18mph) because the roads were particularly snow covered. She describes the other vehicle as being a large SUV-type Volkswagen but she was unable to estimate the speed at which it was travelling. Mrs
tells me that she had no warning of the collision. She recalls a very loud “bang” and she remembers
being “shocked” and “disorientated”. As a result of the impact, Mrs
road, ending up on the opposite side of the carriageway, facing in the other direction. I understand that Mrs
did not sustain any head injury or loss of consciousness as a result of the collision and, indeed, she seems to
have a good recollection of the events. She tells me that, as a result of the collision, she recalls her torso being initially forcefully thrown to the left-hand side and then being thrown around the car as a result of the spinning motion of the vehicle. She informs me that, at the time of the accident, she was wearing a standard 3-point seatbelt and that the seats had appropriately-adjusted headrests. No airbags were deployed at the time of the collision. Mrs
tells me that she was able to mobilise independently from the vehicle immediately after the collision
and that her initial action was to check on her young grandson, who was sitting in his car seat behind the front passenger seat. She tells me that she was not immediately aware of any symptoms at that time. Following some discussions with the driver of the other vehicle, Mrs
from the scene of the accident; I understand that she initially drove to the nursery school to advise them that her grandson would not be attending that day and that she subsequently made her way home. I understand that no police or other emergency services attended the scene of the accident. Shortly after the accident, Mrs
met with her husband and they jointly initiated contact to their insurance
grandson became very distressed and inconsolable and, on the
General Practitioner, they attended the Accident & Emergency Department at Crosshouse
tells me that she was not immediately aware of any symptoms immediately after the collision. It was
only when she attended the Accident & Emergency Department at Crosshouse Hospital with her grandson that she became aware of some pain in the centre of her neck radiating towards her right trapezius and pain radiating down the right side of her lower back. Review of Mrs
copy medical records shows a discharge letter from the Accident & Emergency Department at
Crosshouse Hospital confirming her attendance on 8 December 2010 at 2.43pm. This indicates that she was diagnosed with a “muscle strain of neck” and she was discharged with a diagnosis “minor whiplash injury”. I understand that no X-ray investigations were carried out at that time. Mrs
tells me that, over the 2–3 days following the accident, the pain in her neck progressively worsened.
She describes this as being a “constant” and “severe” pain localised to the right para-vertebral area of the cervical spine, radiating down into the right trapezius and para-scapular area. She also tells me that this progressed into radiating down the right side of the thoraco-lumbar area of her back. Mrs
also describes developing a very severe occipital headache radiating round the vertex of her head.
She tells me that she found this particularly “distressing” and “uncomfortable”.
She described this to me as being a “severe pressure” and that she felt as though “her head was about to burst open”. She tells me that this was exacerbated by any movements and that it was only partially relieved by the painkillers given to her by the hospital. Mrs
tells me that her symptoms of headache, neck pain and back pain were particularly “constant” and
“severe” for the 2 week period after the accident. She found that her sleep pattern was significantly affected during this time, in that she was only able to sleep for perhaps 2-3 hours at a time. Beyond this, she felt that she had to get out of bed and sit in a chair to wait for additional painkillers to take effect. As a result of these ongoing symptoms Mrs
sought the review of her General Practitioner on a number of
occasions. Review of her copy medical records indicates an attendance on 13 December 2010, during which the General Practitioner recorded “worsening neck and lower back pains” and “occipital headaches extending up over head”. The General Practitioner reviewed the painkillers prescribed to Mrs
informs me that, after the initial 2 week period when her symptoms were very severe, she had a
further 3 week period when her symptoms continued, although they were perhaps somewhat less severe. She continued to have headaches during this time, although the severity and frequency of these had improved and her sleep pattern was better. She continued to experience pain in her neck and back but this was largely aggravated by posture and any kind of movement and lifting. During this 5 week period following the accident, Mrs
was not able to perform her work duties and she was
“signed off” work from the date of the accident through to 7 January 2011. Mrs
this period, she was not able to perform her normal domestic tasks, including driving her grandchildren, shopping and domestic cleaning chores, such as Hoovering. She tells me that her husband helped during this time. Mrs
sought further review from her General Practitioner on 16 December 2010 and again on 6 January
2011. During that time it is recorded in her medical records gradual improvement in her symptoms and, at the time of her last attendance on 6 January 2011, Mrs
also tells me that, during her recovery period after the accident, she found her mood was “a bit low”.
She informs me that she has had previous problems with low mood, which has previously been labelled in the General Practitioner’s records as “depressive disorder”. I understand from Mrs
prior to the road traffic accident on 8 December 2010, as a result of the recurrence of her husband’s cancer. She found that she was frustrated during her recovery period because she was not able to help her husband more and she alluded to feeling guilty that he was left to perform the household chores during his illness. However, she found it difficult to quantify just how the symptoms she was experiencing and the loss of her functional ability during this time affected her mood. Mrs
tells me that she did not specifically discuss this with her General Practitioner
and she tells me that her mood is now back to its “normal level” and that this was a transient episode. 3.6
tells me that she still has some ongoing problems as a result of the accident; I understand that she
continues to have some pain well localised to the right para-vertebral area at the base of her neck, however, she tells me that this is exacerbated on extreme lateral rotation of her neck and that it settles when she returns her neck to a normal position. She tells me that she very occasionally has pain in the right lumbar area of her back and that this is entirely related to posture or to sitting for protracted periods of time.
She also finds generally that there is an ache in her back on standing but this settles rapidly after she takes “a few steps”. She informs me that she is still troubled whilst lying in bed and she often has to change position to find a more comfortable posture. She also tells me that she still takes Anadin Extra painkillers orally approximately twice a day on most days of the week. Mrs
informs me that, despite these ongoing symptoms, she feels that she is back to her “normal ability”
and that that there are no specific tasks or duties expected of her, particularly from her work, that she is not able to perform. Indeed, she subjectively rates her ability to perform her work duties at 100% of her normal ability. When asked, she quantified her ongoing symptoms as more of a “niggle”, rather than as a severe inconvenience or distress. Mrs
also tells me that she has returned to her full recreational activities at a level similar to that of before
feels that her mood has entirely returned to its “normal” level.
has not had any physiotherapy as a result of these injuries. Furthermore, as a result
of these injuries, she has attended the Accident & Emergency Department at Crosshouse Hospital on one occasion, she has attended her General Practitioner on 3 occasions and she did not have any radiological investigations performed. 3.7
was alert and orientated during the entire consultation and she was able to understand fully the
purpose of the interview and examination. She mobilised with a normal posture and gait, and I note her somewhat short stature. At no time during the consultation was she particularly distressed or uncomfortable. Routine examination of the cardio-vascular, respiratory, abdominal and neurological systems was unremarkable. Examination of the dorsal spine demonstrated a normal spinal curvature, with no evidence of any focal vertebral mid-line tenderness. Mrs
demonstrated an appropriate comfortable forward flexion/extension and rotation
across her dorsal spine, with no distress. Examination of the cervical spine demonstrated a normal spinal curvature, with no evidence of any nuchal protuberance tenderness. Mrs
described subjective tenderness over the mid-line of C6/C7 on palpation
and also on palpation of the body of the right trapezius muscle. She also described some minimal subjective tenderness on palpation of the right para-scapular area. She demonstrated a full range of comfortable forward flexion/extension and lateral flexion of the neck. There was a loss of lateral rotation of the cervical spine of approximately 20o in both directions, with some subjective discomfort, particularly on lateral rotation to the left side. Examination of the upper limbs and shoulder girdle was essentially unremarkable. 3.8
The mechanism of injury, and symptoms described by Mrs
, are entirely in keeping with sustaining an
acute forward flexion/extension injury across the cervical spine, resulting in an acute cervical spine sprain. This has arisen to the pattern of injuries more commonly known as a whiplash-associated disorder, which would account for the pain and discomfort in Mrs
neck, lower back and associated headaches.
It is my opinion that these injuries are as a direct result of Mrs
involvement in the road traffic collision on
8 December 2010, as there is a direct association between the onset of the symptoms and the date of the accident and there is an absence of any symptoms immediate preceding the accident to explain these injuries. Furthermore, it is reasonable to suggest that, had Mrs
not been involved in the road traffic collision on 8 December 2010,
she would not have experienced the period of injury and suffering as outlined above. It is also my opinion that the previous injuries sustained as a result of a road traffic accident in 1996 have not contributed to this episode of suffering, as there has been a significant period where she has been symptom-free (14 years) and the symptoms at that time were localised to the left side of her neck. The episode of back pain during the summer of 2010 is likely to be a transient episode of mechanical back pain, which, again, would not have contributed to the symptoms of back pain in this case. It is recognised that concurrent features of depressive mood can affect the healing period for this type of injury. It is almost certain that Mrs
mood had been affected prior to her involvement in the road traffic accident
on 8 December 2010 because of the unfortunate recurrence of her husband’s cancer. It is difficult to say how her symptoms of pain and discomfort contributed subsequently to these ongoing depressive symptoms, however, it is reasonable to suggest that the pain and discomfort described by Mrs
husband with domestic duties at that time will have contributed negatively to her mood. Consensus of opinion would suggest that a reasonable time for recovery from these ongoing symptoms would be in the order of 9-12 months from the date of injury. This would leave Mrs
approximately 4-7 months for further recovery from the ongoing symptoms. It is likely that during this time Mrs
will continue to have episodes of occasional discomfort, which will gradually settle in terms of frequency,
duration and severity. It is also likely that she will need to continue to self-administer some simple analgesia during this period. I note that Mrs
has not had any physiotherapy for these injuries and I believe that this may offer her some
benefit and also accelerate her healing, however, I do not feel that this should exceed 6-8 sessions. I do not expect there to be any long-term impact to the life expectancy of the claimant, nor to her employment opportunities on the open job market.
Declaration & Signature 1/ I understand my over-riding duty is to the court, both in preparing reports and giving oral evidence. I have complied with, and will continue to comply with, that duty. 2/ I am aware of the requirements of part 35 and practice direction 35, the protocol for instructing experts to give evidence in civil claims, and the practice direction on pre-action conduct. 3/ I have set out in my report what I understand from those instructing me to be the questions in respect of which my opinion as an expert is required. 4/ I have done my best in preparing this report to be accurate and complete. I have mentioned all matters
that I regard as relevant to the opinions I have expressed. All of the matters on which I have expressed an opinion lie within my field of expertise.
5/ I have drawn attention to all matters, of which I am aware, that might adversely affect my opinion. 6/ Wherever I have no personal knowledge I have indicated the source of factual information. 7/ I have not included or excluded anything which has been suggested to me by anyone, including those instructing me, without forming my own independent view of the matter. 8/ I will notify those instructing me if, for any reason, I subsequently consider that the report requires any correction or qualification. 9/ I understand that this report will be the evidence that I will given under oath, subject to any correction or qualification I may make before swearing to its veracity, and I may be cross-examined on my report by a cross-examiner assisted by an expert. 10/ I have not entered into any agreement where the amount of payment of my fee is in any way dependent on the outcome of the case. Statement of Truth I confirm I have made clear which facts and matters referred to in this report are within my own knowledge and which are not. Those that are within my knowledge I confirm to be true. The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer. Signature: ……………………………………………………………………